B.40 Hypertension. TX. Hypertensive Heart Disease Flashcards
B.40 Hypertension. TX. Hypertensive Heart Disease
Non-Pharmacological TX
Lifestyle Changes for Managing Hypertension
- Weight Loss: Aim for a reduction of 1 mm Hg per kg of weight lost in overweight individuals.
- DASH Diet: Follow a diet rich in fruits, vegetables, whole grains, and low in saturated and trans fats.
- Reduce Sodium Intake: Limit daily sodium consumption to less than 1500 mg.
Physical Activity:
- Aerobic Exercise: Engage in 90–150 minutes per week.
- Dynamic Resistance Training: Focus on 70–80% of maximum strength.
- Isometric Exercise: Perform at 30–40% of maximum strength.
- Increase Potassium Intake: Aim for a daily potassium consumption of 3.5–5 g.
Limit Alcohol Consumption:
- Men: ≤ 2 drinks per day.
- Women: ≤ 1 drink per day.
- Quit Smoking: Completely eliminate smoking.
B.40 Hypertension. TX. Hypertensive Heart Disease
Initiation of Pharma
Initiating Treatment
- Number of Antihypertensives:
- For individuals with newly diagnosed hypertension and a blood pressure (BP) of less than 150/90 mm Hg: Start treatment with one primary antihypertensive.
- For those with newly diagnosed hypertension and a BP of 150/90 mm Hg or higher: Initiate treatment with two primary antihypertensives.
Feel free to ask for additional changes or information!
B.40 Hypertension. TX. Hypertensive Heart Disease
Follow up of intiation
- Reassess after one month of starting or altering pharmacological therapy.
- If the treatment goal is not achieved with one medication, consider increasing the dose of the initial drug or adding a second medication.
- If the treatment goal remains unmet with two medications:
Add a third medication.
- Evaluate for secondary causes of hypertension.
- If blood pressure is controlled, schedule re-evaluations every 3–6 months and annually thereafter.
B.40 Hypertension. TX. Hypertensive Heart Disease
First Line Drugs
ACE Inhibitors (ACEi):
Lisinopril, Captopril, Enalapril
Angiotensin II Receptor Blockers (ARBs):
Losartan, Valsartan
Thiazide Diuretics:
Hydrochlorothiazide, Chlorthalidone
Dihydropyridines:
Nifedipine, Amlodipine
Non-Dihydropyridines:
Diltiazem, Verapamil
B.40 Hypertension. TX. Hypertensive Heart Disease
ACE Inhibitors (ACEi)
Examples: Lisinopril, Captopril, Enalapril
Indications: Preferred as the first-line treatment for patients with diabetes mellitus, renal disease (including hypertension), heart failure, and hypertension.
Cautions: ACE inhibitors and ARBs should not be used together.
Side Effects: May cause dry cough and angioedema.
B.40 Hypertension. TX. Hypertensive Heart Disease
Angiotensin II Receptor Blockers (ARBs)
Examples: Losartan, Valsartan
Cautions: Should not be used in combination with ACE inhibitors.
B.40 Hypertension. TX. Hypertensive Heart Disease
Thiazide Diuretics
Examples: Hydrochlorothiazide, Chlorthalidone
Indications: Recommended as a first-line treatment for African Americans, patients sensitive to salt, and those with resistant systolic hypertension.
B.40 Hypertension. TX. Hypertensive Heart Disease
CCB Dihydropyridines
Examples: Nifedipine, Amlodipine
Indications: Recommended as a first-line treatment for African Americans and patients with isolated systolic hypertension.
Side Effects:
Headache, constipation, pedal edema.
Gastroesophageal reflux, bradycardia.
B.40 Hypertension. TX. Hypertensive Heart Disease
CCb Non-Dihydropyridines
Examples: Diltiazem, Verapamil
Cautions: Generally not used in patients with reduced ejection fraction.
Indications: Recommended as a first-line treatment for African Americans and patients with isolated systolic hypertension.
Side Effects:
Headache, constipation, pedal edema.
Gastroesophageal reflux, bradycardia.
B.40 Hypertension. TX. Hypertensive Heart Disease
Second Line Drugs
Beta Blockers (BB)
Propranolol, Metoprolol, Labetalol
Loop Diuretics
Furosemide, Torsemide
Aldosterone Antagonists (MRA)
Eplerenone, Spironolactone
Direct Renin Inhibitors
Aliskiren
Alpha-1 Blockers
Prazosin, Doxazosin
Alpha-2 Agonists
Clonidine
Direct Arterial Vasodilators
Hydralazine
B.40 Hypertension. TX. Hypertensive Heart Disease
TX HTN in Pregnancy
Methyldopa, Labetalol, Hydralazine, and Nifedipine
B.40 Hypertension. TX. Hypertensive Heart Disease
Hypertensive Heart Disease
- Heart issues arising from hypertension result from pressure overload and ventricular hypertrophy.
Types of Hypertension:
- Systemic Hypertension: Leads to left ventricular hypertrophy (concentric), resulting from pressure overload.
- Pulmonary Hypertension: Causes right ventricular hypertrophy and dilation (pulmonary hypertension with cor pulmonale), leading to right ventricular heart failure (RVHF).
Myocyte Hypertrophy:
- Myocyte hypertrophy is an adaptive response; however, there are limits to this adaptation. Persistent hypertension can lead to dysfunction, cardiac dilation, congestive heart failure (CHF), and sudden death.
B.40 Hypertension. TX. Hypertensive Heart Disease
Heart Conditions Related to Hypertension
- Ischemic Heart Disease (IHD)
- Cardiac Hypertrophy
- Congestive Heart Failure (CHF)
- Hypertensive Cardiomyopathy
- Cardiac Arrhythmias
- Renal Damage or Cerebrovascular Stroke
B.40 Hypertension. TX. Hypertensive Heart Disease
Symptoms
- Fatigue
- Irregular Pulse
- Swelling of the Feet
- Dyspnea
- Nausea, Weight Gain, Bloating
- Difficulty Sleeping Flat in Bed
- Nocturia
